Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116151

Jean Mellett, MBA¹, Ronald D. Deprez, PhD, MPH², James Haley, MD, MBA, CPE³, John Branscombe, MSB⁴, and Gregory Merriman, MPH². (1) Planning Department, Eastern Maine Healthcare Systems, Cianchette Building, 43 Whiting Hill Rd, Brewer, ME 04412, 207-973-7443, jmettett@emh.org, (2) Public Health Research Institute, 120 Exchange Street, Portland, ME 04101, (3) Horizon's Health Services, 23 High St., Fort Fairfield, ME 04742, (4) Maine Network for Health, 23 Water Street, Key Plaza 3rd Floor, Bangor, ME 04401

This session will describe the application of tools and processes used to plan and conduct community, practice and patient centered chronic care improvements. We will discuss the Rural Maine Health Improvement Demonstration Project, an ongoing project focused on improving health status of the population in the nine northern and eastern counties of Maine; the assessment process used to develop chronic care services priorities; and, the patient care and practice change process used in implementation—a variation of the Institute for Healthcare Improvement (IHI) collaborative model. Project implementation initially focused on improving the treatment and self-management of rural patients with COPD using evidence based guidelines—GOLD (Global Initiative for Chronic Obstructive Lung Disease). The project addressed practice issues, patient barriers and community support systems in the care improvement process. Baseline measures of office practice were conducted. Each physician practice identified a specific population of COPD patients that could be monitored during implementation. A patient registry was developed during the Collaborative to document and track results of interventions. Results demonstrated that the health care providers have accepted and implemented the guidelines as part of routine practice. Practice outcomes improved significantly from pre- to post intervention based on practice gap analysis and patient chart review. This project demonstrated that 1.Rural physician practices are motivated to adopt evidence-based guidelines in their practices, given the appropriate support for change. 2.In busy practices, external support to assist with process transition is crucial. 3.In the rural setting, adoption of evidence-based guidelines improves patient care.

Learning Objectives: Learning Objectives

Participants will learn 1
How to use a comprehensive community assessment to prioritize chronic care needs of community populations
• A process to implement evidence-based chronic disease guidelines in rural communities and primary care settings. 3
  Process and methods to evaluate chronic care practice improvement projects.

  Keywords: Disease Management, Quality Improvement

  Presenting author's disclosure statement:
  

  I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

  Recorded presentation

  Community Based Chronic Care Services: A Planning and Implementation Model for Evidence Based Improvements at Community and Practice Settings

  The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA